Anemia Prevalence, Treatment in Non-Dialysis CKD Varies by Country
Less than half of anemic patients were prescribed ESAs or iron in the US and France, and a high percentage overall did not have iron indices measured.
Anemia prevalence and management among non-dialysis chronic kidney disease (CKD) patients differs substantially by country, according to new findings presented at the European Renal Association-European Dialysis and Transplant Association 53rd Congress in Vienna.
Michelle M.Y. Wong, MD, MSc, of Arbor Research Collaborative for Health in Ann Arbor, Michigan, and colleagues assessed early data from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDOPPS), an international prospective study of non-dialysis patients with estimated glomerular filtration rates (eGFR) below 60 mL/min/1.73 m2. They identified 5695 patients with CKD stage III to V treated in nephrology clinics in Brazil, France, Germany, and the United States. The average age was 66 to 73 years, and 35% to 49% were women.
The investigators observed that the proportion of patients with hemoglobin (Hgb) levels below a threshold of 11 g/dL increased with declining eGFR in each country. Yet, remarkable disparities in anemia prevalence emerged. Among patients with eGFR below 20 mL/min/1.73 m2, approximately 50% had Hgb levels below 11 g/dL in Brazil and the United States compared with 41% in Germany and 22% in France. For iron status tests, transferrin saturation (TSAT) levels below 20% were found in 34% of patients in France, Germany, and the United States, compared with just 25% of those in Brazil. Ferritin levels below 100 ng/mL were observed in 37% of patients from France, Germany, and the United States, but only 29% in Brazil.
In regard to anemia treatment, 62 to 66% of patients with low Hgb in Brazil and Germany were prescribed an erthyropoiesis-stimulating agent (ESA) and/or iron (mostly oral). In the United States, prescriptions were provided to just 43% of patients with Hgb below 11 g/dL.
"Early data from CKDopps nephrologist practice surveys regarding Hgb thresholds for initiating ESA therapy reveal that differences in treatment preferences among nephrologists likely underlie the variations observed in anemia treatment practices," Dr Wong told Renal & Urology News. As an ongoing study, CKDopps will provide future insights on anemia treatment and their associations with clinical- and patient-reported outcomes, she added.
1. Wong MMY, Tu C, Zepel L, et al. Anemia Prevalence and Treatment Among Patients With Chronic Kidney Disease Stage 3-5: Data from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDOPPS). Nephrol Dial Transplant 31:i16-i17. doi: 10.1093/ndt/gfw123.05.